Provider Demographics
NPI:1184622821
Name:TERHAAR, PETER (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:TERHAAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 W STATE ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1858
Mailing Address - Country:US
Mailing Address - Phone:716-373-1590
Mailing Address - Fax:716-373-9933
Practice Address - Street 1:2626 W STATE ST
Practice Address - Street 2:SUITE 700
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1858
Practice Address - Country:US
Practice Address - Phone:716-373-1590
Practice Address - Fax:716-373-9933
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200043584OtherRAILROAD MEDICARE
NY02282828Medicaid
NY200043583OtherRAILROAD MEDICARE
PA0014825680007Medicaid
PA200043584OtherRAILROAD MEDICARE
NYDD1302Medicare PIN
NY200043583OtherRAILROAD MEDICARE